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Orthopaedics · London

Manipulation of joints under anaesthetic, by a consultant orthopaedic surgeon.

A controlled, gentle release of a stiff shoulder, knee, hip or elbow - under GA with a regional block, in a proper theatre, with physio that starts the same day.

See indicative pricing
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What a private MUA costs in London.

Indicative ranges across UK private providers.

In short

£2,000–£3,500, home the same day.

Procedure Indicative range
MUA shoulder (adhesive capsulitis) £2,000–£3,500
MUA shoulder + hydrodilatation £2,500–£4,000
MUA knee post-TKR (arthrofibrosis) £2,500–£4,000
MUA hip / elbow (post-op stiffness) £2,500–£4,000
MUA plus arthroscopic release (if needed) £4,500–£7,500
Consultation only £200–£350

Prices vary by clinic, by which surgeon and anaesthetist do the case, whether a hydrodilatation or arthroscopic release is added on the day, and whether an overnight stay is needed. NHS pathways for MUA remain available via orthopaedics.

The problem

The right surgeon, the right timing, the right rehab.

MUA is quietly one of the most time-sensitive procedures in orthopaedics - do it too early and the joint is not ready, too late and the scar tissue is set. Miss the physio window afterwards and the whole thing is wasted.

  • Not sure it is time?

    For frozen shoulder we want six months plus, failed physio, failed steroid, ideally failed hydrodilatation. For a stiff TKR we want six to twelve weeks post-op. We say so honestly.

  • Worried about a fracture?

    The main serious risk is a humeral fracture in an osteoporotic shoulder. A DEXA and an X-ray beforehand let the surgeon decide safely.

  • Want physio done properly?

    Physio starts within hours, twice or three times a week for four to six weeks.

When it helps

When MUA is the right step.

The situations we see most, plus the one red flag that means MUA is not safe today.

  • Adhesive capsulitis (frozen shoulder)

    Frozen phase, six months plus of pain and stiffness after failed physio, intra-articular steroid and hydrodilatation.

  • Stiff knee after replacement

    Range of motion under 100° at six to twelve weeks post-TKR, despite full physio - the window for MUA is short.

  • Arthrofibrosis

    Dense intra-articular scar tissue after knee, hip or elbow surgery that will not stretch out with physio alone.

  • Stiff shoulder after cuff repair

    Loss of passive range following rotator cuff repair, once the repair itself is healed enough to tolerate manipulation.

  • Post-fracture stiffness

    A joint that has stiffened after immobilisation for a fracture, once the fracture is fully united on X-ray.

  • Stiff hip after THR

    Restricted flexion or rotation after total hip replacement that is limiting sitting, driving or shoe-tying.

  • Elbow stiffness

    Loss of extension or flexion at the elbow after trauma or surgery, once other blocks (heterotopic bone, loose body) are excluded.

  • Red flag: fresh fracture or infection

    A recent unhealed fracture, active joint infection, or dense heterotopic ossification means MUA is not safe - this is not the right procedure.

Procedure options

MUA alone is not the only option.

What each option on the table actually involves - and which fits which joint and which problem.

  • MUA shoulder

    Gentle passive cycling through flexion, abduction, external and internal rotation under GA with an interscalene block.

  • MUA shoulder + hydrodilatation

    Manipulation combined with a large-volume saline and steroid injection into the joint - often the most durable option for frozen shoulder.

  • MUA knee (post-TKR)

    Controlled flexion beyond the achieved range, under GA and an adductor canal block, to break down early arthrofibrosis.

  • MUA hip

    Passive flexion, rotation and abduction under GA to restore range after replacement or prolonged stiffness.

  • MUA elbow

    Careful passive extension and flexion under GA - often combined with arthroscopy if a bony or loose-body block is suspected.

  • MUA plus arthroscopic release

    Where manipulation alone will not free the joint, the surgeon proceeds to keyhole release of the capsule at the same anaesthetic.

  • Repeat MUA

    A second MUA is sometimes needed for frozen shoulder - around a third recur within six months. We say so honestly beforehand.

  • Consultation only

    An honest discussion of whether MUA is the right next step, or whether more physio, injection or open surgery fits better.

Safety and recovery

What to expect afterwards - honestly.

MUA is a short, well-established day-case procedure. The things worth planning are your regional block, the physio schedule, and knowing what a normal post-op flare looks like.

  • Regional block plus GA

    A light GA with a regional block (interscalene for shoulder, adductor canal for knee) means good pain control before the physio starts.

  • Audible pops are usually normal

    The pops and clunks heard during manipulation are adhesions releasing, not fractures - but the surgeon stops if resistance feels wrong.

  • Post-op flare pain for 48 hours

    A sharp increase in pain for one to two days after MUA is expected. Regular pain relief and ice make the difference.

  • Physio within hours is not optional

    The range gained under anaesthetic is lost in days without aggressive early physio - miss the first sessions and much of the benefit goes.

  • CPM for the knee, three to four weeks

    A continuous passive motion machine is used at home after knee MUA to protect the new range while the joint is inflamed.

  • Humeral fracture - rare, mostly elderly

    The main serious risk of shoulder MUA is a fracture of the humerus - uncommon, and more so in elderly, osteoporotic bone.

  • Recurrent stiffness - around a third

    Roughly a third of frozen shoulders stiffen again within six months. A second MUA, or arthroscopic release, is sometimes needed.

  • DVT and PE risk after lower-limb MUA

    Knee and hip MUA carry a small DVT and PE risk - chemical prophylaxis and early mobilisation are used to minimise it.

  • Red flags

    Sudden loss of the range you just gained, fever, spreading warmth, or new severe pain after the first 48 hours are not normal - call the team the same day.

Reading your operation note

Your operation note in four parts. Read the last one first.

Whichever joint was treated, the note the surgeon sends you keeps to the same shape.

A UK consultant orthopaedic surgeon reviewing a patient’s operation notes after MUA

A quiet reminder

Surgical language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the note before your physio-led review, just ask.

  1. 01 Header

    Indication and joint treated

    Why the MUA was done - frozen shoulder, stiff TKR, arthrofibrosis - and which joint, on which side.

  2. 02 Technique

    Anaesthetic and manipulation technique

    The block used, the sequence of movements, the range achieved, and whether an arthroscopic release or hydrodilatation was added.

  3. 03 Findings

    Range gained and any complications

    Passive range before and after in degrees, quality of end-feel, and any intra-operative issues such as crepitus or bleeding.

  4. 04 Impression

    Physio plan and follow-up

    Read this first: the physio schedule, the CPM plan for the knee, when to return, and what to call about.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

MUA for frozen shoulder and post-operative stiffness is typically covered by UK health insurers when medically indicated.

Frequently asked

Everything we get asked about MUA.

Quick answers on timing, pain, cost, physio and what happens if MUA alone is not enough.

  • What is a manipulation under anaesthetic (MUA)?

    A short procedure in which the surgeon moves a stiff joint through its full passive range while you are asleep under a general anaesthetic, usually with a regional block for pain relief. It is used for adhesive capsulitis (frozen shoulder), stiff knees after replacement, arthrofibrosis, and other post-operative or post-fracture stiffness.

  • When is MUA offered for a frozen shoulder?

    Usually in the frozen phase, after around six months of symptoms, once physiotherapy, an intra-articular steroid injection and - often - a hydrodilatation have all failed to restore useful range. UK BESS and BOA guidance supports MUA (often combined with hydrodilatation) at this point rather than earlier.

  • When is MUA offered after a knee replacement?

    When knee flexion is under about 100° at six to twelve weeks after a total knee replacement, despite full physio. The window matters: MUA works best in the first three months, before the scar tissue matures.

  • Does MUA hurt?

    During the procedure you feel nothing - you are asleep, with a regional block on top. For the first 24 to 48 hours afterwards there is a flare of soreness and swelling, which is expected and controlled with regular pain relief and ice.

  • How much does a private MUA cost in London?

    Roughly £2,000–£3,500 for a shoulder MUA, £2,500–£4,000 with hydrodilatation added, £2,500–£4,000 for a post-TKR knee MUA, and £4,500–£7,500 if an arthroscopic release is added at the same anaesthetic.

  • Why does physio need to start on the same day?

    The range of motion regained under anaesthetic is held open by aggressive early movement. Without physio within hours - and two to three sessions a week for four to six weeks after - the joint stiffens again quickly and much of the MUA benefit is lost.

  • What are the risks of MUA?

    The main risks are a fracture of the humerus (rare, and largely in elderly osteoporotic shoulders), rotator cuff tear (rare), cartilage or nerve traction injury, DVT or PE after lower-limb MUA, a post-op pain flare for 48 hours, incomplete gain in range, recurrent stiffness - around a third for frozen shoulder - and occasionally needing to proceed to an arthroscopic release.

  • What happens if MUA is not enough?

    If manipulation alone will not free the joint, the surgeon can proceed to a keyhole arthroscopic capsular release at the same anaesthetic - this is discussed and consented for beforehand. A repeat MUA is also an option for frozen shoulder that stiffens again.

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